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Young women ages 18 to 25 represent a heterogeneous population transitioning from adolescence into adulthood who might present with unique issues and challenges, including a potential gap in healthcare after pediatric healthcare. The American College of Obstetrics and Gynecology (ACOG) has just released a committee opinion to help providers structure preventive healthcare visits to screen for health issues and counsel patients about a variety of health topics, including reproductive health.1
In 2011, the U.S. population was more than 311 million.2 Women ages 18-24 comprised 9.6% of the 158 million U.S. females. This age group might need assistance in transitioning from a pediatrician to a provider of adult healthcare, notes Julie Strickland, MD, chair of ACOG’s Adolescent Health Care Committee, which issued the opinion.
Young women in this age group often have some gaps in medical care, Strickland observes. Often, they are newly on their own and don’t really know what provider to use to assess their needs. Also, young women might feel well, so they don’t go for sick visits, but yet have a lot of screening needs, Strickland states.
Many young women come to view their obstetrician-gynecologist as their primary health provider.3 In a preventive healthcare visit, providers should screen for health issues and counsel patients about a variety of health topics, some of which are particularly relevant to their age group.1
During the visit, ask about the young woman’s living situation, including with whom she lives, how well she gets along with others at home, and whether she feels safe and secure. Questions about friends’ high-risk behaviors such as alcohol consumption and drug use can make the patient more receptive to answering questions about her own personal habits.
Assess a patient’s social support, says Melanie Gold, DO, MQT, DABMA, FAAP, FACOP, medical director of New York — Presbyterian Hospital’s School Based Health Centers and adolescent medicine faculty at Columbia University Medical Center in New York City. Identify who might be an advocate for a young woman’s care, whether it might be her mother, an aunt, or a trusted friend, Gold says.
Talk with your patient about whether she has any concerns or questions about the shape or size of her body or the way she looks, the guidance advises. Ask whether she wants to gain or lose weight, and if she has ever tried to lose weight or control her weight by vomiting, using diet pills or laxatives, or not eating for a day. Questions about intake of fruits and vegetables, calcium, multivitamin with folic acid, iron, and dietary restrictions can help you understand dietary behaviors. Be sure to check use of herbal and natural supplements, because some supplements can interfere with certain prescription medications; for example, St. John’s wort interferes with the efficacy of oral contraceptive pills.
Because injuries are the most common preventable cause of morbidity and mortality among young women, safety questions are important facets of the preventive visit. All patients should be asked about abuse, neglect, physical or sexual violence, and reproductive coercion, such as sabotage of contraceptive methods.1
Gold says she sees sleep disorders in this age group, as young women are juggling multiple responsibilities such as school, job, and family. Lack of sleep can lead to increased risk of diabetes, weight gain, heart disease, depression, driving accidents, and mistakes at school or work.1(Use resources from the federal National Institutes of Health’s National Heart, Lung, and Blood Institute for additional information and resources on sleep. Visit http://1.usa.gov/1Evgg1W.)